66580D - Grainger

71CAMA / ❑ DREDGE & FILL
►"ENERAL PERMIT
*New ❑Modification ❑Complete Reissue El Partial Reissue
db L. S fN hC ID fE ' dN IR
A B
Previous permit #
Date previous permit issued
)raze y t e tate o ort aro rna, epartment o nvironment an atura esources
Coastal Resources Commission in an area of environmental concern pursuant to 15A NCAC
(�
:t Name 6,9,rnl V �Aot,
Project Location: County
❑ Rules attached.
:Sc N�- -Q-
Street Address/ State Road/ Lot #(s)
a V,,R. State "�
! C� % 'v`\ /` u ' ` \
Oy� �-O�j SE -Mail
Subdivision -
zed Agent i\1 ��k6kk1d.SGV'X �� �����
City uTd- n (�>T6
ZIP_��
❑ CW �`t TEW �TA ❑ ES ElPTS
Phone'# (ql o ) 3t��► - D33
River Basin
❑ OEA ❑ HHF ❑ IH ❑ UBA ❑ WA
Adj. Wtr. Body r� ✓� �l �
nat
❑ PWS:
w
yes / no ) PNA yes /
Closest Maj. Wtr. Body
/ ` I
f Project/ Activity
�7, )\
)ck)length
latform(s)
Platfor(s)
�ier(s)
!ngth
amber
rd/ Ripfap length_
g clitance offshore
axhlistance offshore
ibic yards
mp
us . Boatlift T u j 3
lulldozing
,r
ie Length U
not sure yes 41)
rium: n/a yes no
yes i
Attached: (5 no
ing permit maybe required by: ' ll�Vt t1 tG(
Local Planning jurisdiction) A
n
�.� (Scaler
❑ See note on back regarding River Basin r

NC Division of Coastal Mgt. Habitat Impact Coml
Applicant:
Date:
Describe below the HABITAT disturbances for the application.
All values should match the name, and units of measurement found in your Habitat code sheet.
TOTAL Sq. Ft.
FINAL Sq. Ft.
TOTAL Feet
FIB
(Applied for.
(Anticipated final
(Applied for.
(An
DISTURB TYPE
Disturbance total
disturbance.
Disturbance
dist
Habitat Name
Choose One
includes any
Excludes any
total includes
Exc
anticipated
restoration
any anticipated
res'
restoration or
and/or temp
restoration or
tern
ternimpacts)—impact
amount)
ternimpacts)
am
6VJDredge
❑ Fill ❑ Both ❑ Other
�
f � l
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑
Dredge ❑ Fill ❑ Both ❑ Other ❑

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Coastal Management
Beverly Eaves Perdue James H. Gregson
Governor Director
Dee Freema
Secretar
AGENT AUTHORIZATION FORM
Date:
Name of Property Owner Applying for Permit: 1Name of Authorized Agent for this project:
Czf'c; n c e t l'V ilk nd c
Owner's Mailing Address:
poiCf L-3eaz�..tiic,
Agent's Mailing Address:
SL1.lie A 1�4 >\ � c , a� L1 W
Phone Number (�'1 ) O)Q 0� — R 9/'S Phone Number tl ) D)
I certify that I have authorized the agent listed above to act on my behalf, for the purpose of applying
for and obtaining all CAMA Permits necessary to install or construct the following (activity):
� it [,, t' —Zo sts, L tQ,� i` r,-
(my property located) at is C? r
This certification is valid thru (date) — w
5^ice i�
Pr rty Owner Signature Date

ADJACENT RIPAM&N PROPERTY OWNER STAMWENT
(FORA MM MOOIWVGPLUN(,S/BOAT'LIFTBOATHOUSE)
I hereby certify that I own property adjacent to�C'Pu GPc< r�� r 's
{Name Property
property located at _ o� `� a4 ✓' 1 I b c ,
.(Lot, Block, Road, etc.)
on C C t r t �� , in t-f �) 4 n � <<c�� , N.C..
(Waterbody) {Town and/or County) ff
Applicant's phont, #: q f D � S Mauling Address. I a Ct' &J Q f l �' n l� r
He has described to me, as shown below, the development he is proposing at that location, and, I
have no objections to his proposal. I understand that a pier/mooring pilings / boatIM I boathouse
must be set back a minimum distance of fifteen feet (15D from my area of riparian access unless
waived by ono. (If you wish to waive the setback, you must initial the appropriate blank
below.)
i do pat wish to waive
1r5 S I do wish to waive that setback requirement.
DESCRIPTION AIvD/ORDRAWWG OF PROPOSED DEVELOPMENT:
(To be filled in by indfvfdual proposing development)
(Information for Property Owner Applying
for Permit)
Mailing Address
City. tare! ip
(Riparian Property Owner Information)
A��,
Signature
'sk uwve r
Print or'I`ype Name
7W- L/5/ -aoq y

May.17.2016 12:10 PM Richardson Const & Maxine 9108425597 PAGE. 3/
AWACXNT JOPA,RA.NPROPERT"Y OARSTA.TEvEM
(FOR APJZX&00.R?7+fGP.iU G"0AT 0WOA.THOUSE)
I hereby ccrti£y that I own propem adjaceat to
•(1.VameVProp" er)
pmpe* locked at 1 `/ 6jj ° n ._ r
qAt, Bloc11ktt, Road, eta)
bn _ �' G ti� , in 1'fi?I 2 �. , N.C..
(Waterbody) •(rmm 8gd/or County)
A�p)3ca»Ysphane i0 d� •�(S it gAdd�x :_�r�_
l-Jr, has described to me, as shown below, Ie development be is pznpooing et t'ht loo4on, and, I
have no objections to his pzopt»sal. I uvd=tand, that a pier/mom ing pilings / boatlift / boathowa
must be set back a minmaw distance of ffmu inset (I5) Arom my arcs of z4odan access vmless
waived by me. (Ifyou vdsb to Raive t bo actbaok, you m=t initial the appropriate bl k
below.)
I d o sot V*hto waive
I dam. wish to waive that wftck xagxdr==L
'DEBC,I FMN ANDIORDPAWING, OF MOPOSED DY'VF.IiOI'MT:
(To be flUed bt by tn`4tuw4al-{propoahtg dodopm o
r%u)C.t�t J
¢ut'ora;a. en for Pmpwrty Owv*r Applying
forPenaM
3L�S-76ek- 0,re. ker &,)
lvielliul Address
�,,., aQL,
Cityl�`ttxt�,p
Zorfa Ntmber � Te/i/spbone Ntanbcr

Canal
DECK
20'-0" x V-0" UP
Proposed Boat lift
L — 13x13
it II
Modified structur
14--10 1 /4"
(I New Aluminum Rai
ting Structures
\>n
�� II
2'r 11 a--1-------
I1 15,
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